Eating Disorders

Financial Burden of Bulimia Nervosa: Cost of Food, Laxatives, Diuretics, and Diet Pills Adds Up

Tetyana 12 Comments

The financial burden of bulimia nervosa can be substantial, and yet little is known about the monetary costs associated with bulimic symptoms. At least little is known in academic circles – there is definitely a lot of anecdotal evidence floating around the internet. I found just one paper from 2009 by Scott J. Crow and colleagues. I stumbled upon it accidentally, actually. I was searching for articles on the economic burden of eating disorders (treatment cost, productivity loss, etc..) for a post I’m planning, but I thought I’d write about this in the mean time.

It is a short paper but I think it is important because it highlights an often overlooked issue.

The method Crow et al used to evaluate how much money individuals with bulimia nervosa spend on food, laxatives, diuretics and diet pills is simple (keep in mind, this hasn’t really been done before). Essentially, they asked … Continue reading →

How Can We Treat Chronic and Severe Anorexia Nervosa? (On the Need for New Approaches)

Tetyana 27 Comments

Treating anorexia nervosa is hard. Treating chronic and severe anorexia nervosa is a lot harder. Although the situation seems to be improving, there are really no evidence-based treatments for anorexia nervosa – particularly for those who have been sick for a long time.

Patients with severe and enduring anorexia nervosa have one of the most challenging disorders in mental health care  (Strober, 2010).They have the highest mortality rate of any mental illness with markedly reduced life expectancy (Harbottle et al., 2008). At 20 years the mortality rate is 20%, and given the young age of onset this results in many young adults dying in their 30s, and a further 5–10% every decade thereafter (Steinhausen, 2002)… Patients are often under- or unemployed, on sickness benefits, suffer multiple medical complications… have repeated admissions to general and specialist medical facilities, and are frequent users of primary care services (Birmingham and Treasure, 2010;

… Continue reading →

Understanding Disordered Eating in Trans People

Tetyana 17 Comments

Gender nonconformity is the second most popular search term that leads people to Science of Eating Disorders. (After “science of eds” and beating “science of eating disorders”.) Not far behind are variants of “FtM/MtF/transsexual/transgender” combined with “eating disorder/anorexia/bulimia”. That’s telling. It means there is little information on this topic. And it is not just that there’s too little information available to the public – there are only a handful of published studies in the peer-reviewed literature.

One study (which I discussed in my previous post: Gender Nonconformity, Transsexuality and Eating Disorders) published by Vocks et al (2009), compared disordered eating patterns, body image disturbances and self-image scores among trans women and men (131 participants in both groups) and cis female and male controls as well as to females with eating disorders.

Overall, they found disordered eating patterns reported by trans women and trans men were in the middle … Continue reading →

Medical Complications in Patients with Eating Disorders: An ER Perspective

Tetyana 7 Comments

A healthy-looking young woman comes into the emergency room complaining of lightheadedness, dizziness, tiredness, dehydration and constipation. She tells you she doesn’t know what’s wrong, but what she is not telling you is that she has an eating disorder. How do you find out? More importantly, how do you avoid complications that may arise from using conventional treatments for patients without eating disorders?

I often come across questions posted on websites and forums asking if others have experienced a particular symptom, what could be causing it and whether going to the hospital is necessary. I am not a physician, not training to be a physician and not doing research in anything directly relevant to medicine or health. Moreover, I always use caution when answering questions online – the best advice is to go see a doctor (but of course, that’s not always possible, unfortunately).

My goal with this post … Continue reading →

What You Should Know About Anorexia Nervosa and Bone Health

Tetyana 7 Comments

Recovery from an eating disorder is really hard. Unfortunately, the negative effects of that occur as a result of the eating disorder often persist long after recovery. It is hard to undo the mental and psychological aspects of anorexia or bulimia nervosa, but it may be just as hard, if not impossible, to undo the damage done to body.

What are some of the long-term health effects of eating disorders? What do patients with eating disorders – recovered or not – have to live with, for years, often decades, after recovery?

A really common consequence of anorexia nervosa is osteoporosis: thinning of bone tissue and loss of bone density. Unlike delayed gastric emptying – another consequence of EDs – which can make every meal a nightmare (particularly for someone recovering from an eating disorder): acid reflux, stomach pain and abdominal bloating are just some of the symptoms, bone density … Continue reading →

Are All Anorexia Nervosa Patients Just Afraid Of Being Fat and Can We Blame The Western Media?

Tetyana 42 Comments

A really fun aspect of blogging is seeing what search terms lead people to my blog; a frustrating side-effect is not being able to interact with those people directly. This entry is, in part, an attempt to answer a common question that leads individuals to my blog. Common question or search queries are variants of the following (these are actual search terms that led to this blog, I corrected spelling mistakes): “do models cause eating disorders in women?”, “pictures of skinny models linked to eating disorders”, “do the images of models in magazines cause eating disorders?”, “eating disorders relating to thin models”, “psychiatrists thought on how skinny models are causing eating disorders”, “thin models are to blame for eating disorder.”

Well, you get the point.

I briefly started tackling the notions that the “thin ideal” promoted by Western media is to blame for the prevalence of eating disorders and a … Continue reading →

When Clinicians Do More Harm Than Good – Part 2 (Risks Associated with Treatment)

Tetyana 6 Comments

My previous post on the effectiveness of residential treatment centers (RTCs) generated a lot of discussion. A point that was raised several times, on the blog, on Facebook and other forums was the fact that there are risks in choosing an RTC for treatment.

Laura Collins did a great job of articulating some of the risks in her comment:

Among the risks: delaying necessary changes at home, disempowering or alienating relationships at home that are necessary for longterm health, exposure to behaviors and habits that had not been an issue previously, exposure to unhealthy relationships with other clients, an artificial environment that can’t translate to life after RTC, and therapeutic methods or beliefs that are false or don’t apply.

There risks are not specific to RTCs. They hold true for inpatient treatment, partial hospitalization and to a lesser extent, outpatient treatment. I thought it would be nice to explore in … Continue reading →

Should Insurance Companies Cover Residential Treatment for Eating Disorders?

Tetyana 48 Comments

Should insurance companies cover residential treatment for eating disorders?  The price tag is high, about $1,000/day on average, but evidence of treatment effectiveness  is astonishingly low. Practically nil, as I’ve recently discovered. Despite spending my free time punching away different keywords into the PubMed search bar, I came up with very little. And you know what I think? I think treatment centers should be embarrassed. And I think, wow, maybe insurance companies have a point? (A scary thought! I don’t actually think they do, though – but then, I just can’t wrap my head around for-profit healthcare, having lived all my life with socialized healthcare, and loving it.)

Carrie over at ED-Bites recently blogged about the fact that there a dearth of evidence-based treatment for eating disorders. It is a complicated issue, I know, but I do think that any organization or center that offers treatment (especially … Continue reading →

Eating Disorders: Do Men and Women Differ?

Tetyana 9 Comments

Given that eating disorders disproportionately affect women, it is not unreasonable to assume that men differ from women in clinical presentation, personality and psychological characteristics. My guess would be that they differ. My reasoning is this: males and females grow up facing different pressures and expectations. Given that, I’d think there would be (perhaps only slightly) different risk factors that predispose men and women to develop eating disorders. Thus, I’d think that different groups of men and women (i.e. with different personality characteristics, psychiatric comorbidities, and life experiences) would be susceptible to EDs. (Hopefully that makes sense.) To answer that question, Dr. D. Blake Woodside and colleagues compared men with eating disorders vs. women with eating disorders vs. men without eating disorders.

Why are females much more likely to suffer from eating disorders than males? It appears that (at least) two arguments have been put forth:

One argument has been

… Continue reading →

Predictors of Diagnostic Crossover and Symptom Fluctuation in Eating Disorders

Tetyana 8 Comments

Symptom fluctuation and diagnostic crossover are common in eating disorder patients. A study by Eddy et al. (2008) – who followed patients over an average of 7 years – showed that crossover between subtypes and full-syndrome diagnoses is very common : of those initially diagnosed with anorexia nervosa, almost 73% crossed over to another diagnosis (between symptoms and to bulimia nervosa). More specifically, roughly 50% experienced fluctuation between subtypes (restricting, AN-R, and binge/purge type, AN-BP) and roughly 35% crossed over to bulimia nervosa (a subset experienced both). Of those initially diagnosed with bulimia, roughly 14% crossed over to AN-BP and of those, 3.91% crossed over to AN-R.

This finding (though, well-known to ED specialists and even more well-known to patients) has important implications for treatment. For example, CBT and anti-depressants seem to have positive results in bulimic patients, but not so much in anorexics. What then, about those that crossover … Continue reading →